Senior Third Party Risk Management Analyst United Nations Federal Credit Union
New York, New York27 days ago
- $105,000–$120,000 Per Year
- Full-time
- Employee
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Skills
- Analysis Skillsunmatched
- Automatic Call Distributor (ACD)unmatched
- Case Managementunmatched
- Certified Medical Assistantunmatched
- Clinical Informationunmatched
- Clinical Information Systemsunmatched
- Clinical Practices/Protocolsunmatched
- Clinical Study Publicationsunmatched
- Communication Skillsunmatched
- Compensation and Benefitsunmatched
- Copying Machinesunmatched
- Customer Escalationsunmatched
- Customer Support/Serviceunmatched
- Data Entryunmatched
- Document Scannersunmatched
- Documentationunmatched
- Establish Prioritiesunmatched
- Geneticsunmatched
- Health Planunmatched
- Healthcareunmatched
- Healthcare Administrationunmatched
- Healthcare Managementunmatched
- Healthcare Providersunmatched
- Healthcare Softwareunmatched
- High School Diplomaunmatched
- Human Healthunmatched
- Interpersonal Skillsunmatched
- License Managementunmatched
- Licensed Practical Nurse/Licensed Vocational Nurseunmatched
- Maintain Complianceunmatched
- Managed Careunmatched
- Medical Record Systemunmatched
- Medicationsunmatched
- Microsoft Excelunmatched
- Microsoft Officeunmatched
- Microsoft Outlookunmatched
- Microsoft Wordunmatched
- Militaryunmatched
- Multitaskingunmatched
- Nursing Administrationunmatched
- Office Equipmentunmatched
- Operational Supportunmatched
- Organizational Skillsunmatched
- Palliative Careunmatched
- Pharmacyunmatched
- Policy Developmentunmatched
- Prescription Drugsunmatched
- Presentation/Verbal Skillsunmatched
- Procedure Developmentunmatched
- Public Healthunmatched
- Quality Assuranceunmatched
- Quality Managementunmatched
- Regulatory Complianceunmatched
- Regulatory Requirementsunmatched
- Team Playerunmatched
- Time Managementunmatched
- Typingunmatched
- Utilization Managementunmatched
- Writing Skillsunmatched
Description
City/State:
Yonkers, New York
Grant Funded:
No
Department:
NCM - Central Intake Unit
Work Shift:
Day
Work Days:
MON-FRI
Scheduled Hours:
8:30 AM-5 PM
Scheduled Daily Hours:
7.5 HOURS
Pay Range:
$56,000.00-$70,000.00
Job Summary
Under the supervision of a licensed or certified clinical professional, the Care Management Analyst (CMA) is responsible for supporting the operational functions of care management programs, including complex care, chronic care, palliative care, and care transitions. The Care Management Analyst coordinates and manages key care management processes to ensure members receive timely, appropriate, and cost-effective healthcare services while adhering to organizational policies, regulatory requirements, and payer guidelines.
The CMA gathers, reviews, and organizes information from multiple sources, including members, caregivers, physicians, clinical information systems, and electronic health records (EHRs). Using established protocols, the CMA evaluates information related to utilization and benefit application, facilitates care coordination activities, and escalates cases requiring clinical intervention to the appropriate care management staff. A primary responsibility of this role is managing medication prior authorizations through Pharmacy Benefit Managers (PBMs), ensuring timely access to prescribed therapies while meeting payer requirements.
Essential Responsibilities
- Coordinate operational activities supporting complex care, chronic care, palliative care, and care transitions programs.
- Process and manage medication prior authorizations through Pharmacy Benefit Managers (PBMs), health plans, and specialty pharmacies.
- Collect, review, and organize clinical and administrative information from members, caregivers, providers, and electronic health records.
- Evaluate benefit eligibility and utilization information in accordance with established policies, procedures, and clinical guidelines.
- Manage assigned care management processes and/or a designated caseload while ensuring timely follow-up and documentation.
- Collaborate with interdisciplinary care management teams to facilitate appropriate interventions and continuity of care.
- Serve as a resource to team members, physicians, providers, members, caregivers, and internal departments regarding care management processes.
- Maintain accurate documentation within care management and utilization management systems.
- Ensure compliance with organizational, regulatory, and payer requirements while maintaining confidentiality of member information.
- Support quality improvement initiatives and other departmental operational activities as assigned.
Qualifications
Education/ Licensure
- High School Diploma or GED required.
- Bachelor's or master's degree preferred (Nursing, Healthcare Administration, Public Health, or another health or human services fields)
- Current LPN licensure and registration in NY State required.
Experience
- Experience processing medication prior authorizations with Pharmacy Benefit Managers (PBMs), health plans, or specialty pharmacies strongly preferred.
- Experience in medical management within a managed healthcare environment preferred.
- Previous case management, utilization management, care coordination, or population health experience preferred.
- Experience working with electronic health records (EHRs) and clinical documentation systems preferred.
Technical Skills
- Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
- Experience with case management and utilization management software
- Strong data entry and keyboarding skills
- Familiarity with electronic health records (EHRs)
- Experience using electronic fax systems and automated call distribution systems
- Ability to navigate web-based healthcare applications and databases
- Experience operating standard office equipment, including scanners and copiers
Knowledge, Skills & Abilities
- Strong analytical and critical thinking skills
- Excellent organizational and time management abilities
- Effective written and verbal communication skills
- Ability to prioritize multiple assignments in a fast-paced environment
- Strong customer service and interpersonal skills
- Ability to maintain confidentiality and exercise sound judgment
- Ability to work collaboratively with interdisciplinary teams while managing multiple priorities
Montefiore Medical Center is an equal employment opportunity employer. Montefiore Medical Center will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.
Numbers & Facts
| Location | NJ |
| Industry | Healthcare Services |
| Salary | $56,000–$70,000 Per Year |
| Company Size | 10,000 employees or more |
| Website | http://www.montefiore.org/ |
About Company
About Montefiore Medical Center
Commitment to Excellence
As the academic medical center and University Hospital for Albert Einstein College of Medicine, Montefiore Medical Center is nationally recognized for clinical excellence—breaking new ground in research, training the next generation of healthcare leaders, and delivering science-driven, patient-centered care.
Montefiore is ranked among the top hospitals nationally and regionally by U.S. News & World Report. For more than 100 years we have been innovating new treatments, new procedures and new approaches to patient care, producing stellar outcomes and raising the bar for medical centers in the region and around the world. As we build on this momentum, we continue to advance the practice of medicine and set the standard for excellence.
Enduring Mission and Distinguished History
The mission of Montefiore is to heal, to teach, to discover and to advance the health of the communities we serve.
From its beginning in 1884, as a facility for the care of patients with tuberculosis and other chronic illnesses, to the new millennium, Montefiore has been at the forefront of patient care, research and education and steadfast commitment to its community.
Our Services
We provide coordinated, compassionate and leading-edge care designed to reach people when and where they need it most. Through highly integrated teams of physicians, nurses, social workers, mental health professionals and other caregivers, we have created an innovative, seamless system of care focused around the patient.
Notable Centers of Excellence
At the intersection of Einstein science and Montefiore medicine is our commitment to scientific inquiry. This commitment has resulted in the creation of the Montefiore-Einstein Centers of Excellence in cancer care, cardiovascular services, transplantation and children’s health, where nationally recognized investigators and multidisciplinary clinical teams collaborate to develop and deliver advanced, innovative care.
Advanced Specialty and Surgical Care
We offer advanced, multidisciplinary care across specialties, delivering one standard of excellence for all. Our interventions are designed to help patients understand and manage their illness, advocate for their health, access the right treatments and receive the vital social support they need to flourish. On multiple fronts, Montefiore is developing more effective and less invasive approaches to complex problems from procedures to repair diseased hearts, protocols to treat complex cancers and medical devices designed to meet the needs of growing children.
Primary Care
With nearly 50 primary care locations throughout the New York metropolitan area, we are focusing on accessible, patient-centered primary and preventive care provided by leading physicians in the areas of family and internal medicine, pediatrics, obstetrics and gynecology, and a team of experts in nursing, health education, nutrition and pharmacy.
Providing Care Without Walls
Montefiore combines its deep commitment to the community with nationally-renowned expertise to reach people in locations easiest for them. Through Montefiore’s School Health Program (MSHP), Primary Care at Home programs, mobile medical and dental health vans and health education initiatives, Montefiore provides primary care services in non-traditional settings.
Through the formation of highly integrated teams of physicians, nurses, social workers, mental health professionals, care managers and other caregivers, we provide care around the patient, when and where they need it.
Research and Education
Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Together, the two institutions are among 38 academic medical centers nationwide to be awarded a prestigious Clinical and Translational Science Award (CTSA) by the National Institutes of Health.
The second-largest medical residency program in the country, with 1,251 residents and fellows across 89 programs, Montefiore provides the doctors of tomorrow a unique opportunity for education and training in one of the most diverse urban areas in the country — one where the population is global, the disease burden is high, and the need for quality care is great.
The partnership is further strengthened by the dual appointments of faculty and physicians across both organizations—enhancing synergies and collaborations for research, teaching and patient care.
Comprehensive Care Management
Since 1996, Montefiore has developed advanced models of care management to help patients, especially those with chronic diseases such as diabetes, heart failure and mental illness, achieve better health and improved wellbeing in a cost effective way. Montefiore goes beyond fragmented fee-for-service payments, assuming total responsibility for the quality and costs of care for some of our sickest patients.
Through CMO, Montefiore Care Management, we use a global prepayment or similar strategies to manage care for 200,000 individuals over the continuum, including hospital care, rehabilitation, outpatient care, professional services, home care, mental health counseling, community-based services, remote patient monitoring and many other programs.
Our leadership in coordinating care across multiple settings has earned us federal recognition from the Centers for Medicare and Medicaid Services as a Pioneer Accountable Care Organization. Montefiore's ACO is one of only 32 organizations in the nation, as well as the only one in New York State, to operate under this new model of providing Medicare beneficiaries with higher quality care, while reducing expenditures through enhanced care coordination.
Learn More
- Mission, Vision and Values – Montefiore’s unique path of growth into the future and the clinical excellence and outstanding customer care that will get us there.
- History and Milestones – Proud traditions guiding our mission and the moments that helped shape Montefiore into a premier academic medical center.
- Commitment to the Community – Community health, education and neighborhood development.
- Leadership – Executives and clinical chairs leading Montefiore’s advancements.
- Physicians – Widely acclaimed medical professionals and specialists who provide our patients with the highest standards of care.
- Nursing Staff – Highly competent and compassionate professionals committed to improving the health of their patients.
- Ways to Give – Philanthropic opportunities and other ways to support Montefiore Medical Center.
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